Commerce Impacts Access to ‘Artificial Pancreas’ for US Patients

In the meantime, the full 670G system — algorithm-enabled pump plus CGM — is being shipped only to patients enrolled in Medtronic’s Priority Access Program, which was created to allow those who were using the 630G to be the first to switch to the 670G, while new users are receiving just the pump.

One Insurer Says No to the Artificial Pancreas/670G

Adding to frustrations, one major US insurance company, Anthem Blue Cross/Blue Shield, has said it will not cover the Medtronic 670G because it “considers the device to be investigational and not medically necessary.”

In a statement provided to Medscape Medical News, Anthem said that after extensive review, its Medical Policy & Technology Assessment Committee (MTPAC) “concluded that there is not yet enough data on the longer-term safety and efficacy of hybrid closed-loop devices based on review of limited available published studies. These studies involved fewer than 300 people, all of whom had well-controlled diabetes.”

Anthem’s medical policy team will continue to monitor the evidence for the 670G “as more user data/experience and clinical literature become available to better understand the risks and benefits of hybrid closed-loop therapy. Updated information will be presented to the MTPAC at least once a year or sooner if appropriate.”

Medtronic’s Mr Hill told Medscape Medical News that Anthem is the only major commercial payer in the US that has decided not to cover the 670G/artificial pancreas.

“This decision impacts thousands of patients with diabetes who are not able to access this important therapy,” he said, noting that this decision was made despite Medtronic providing Anthem with data from JAMA showing that “patients on the system experienced less glycemic variability, more time in the target range, less exposure to hypoglycemia and hyperglycemia, and reduced A1c when compared with those not on the therapy.”

“We are hopeful Anthem will reevaluate the data we presented and move their decision more in line with the rest of the major payers in the country,” he stressed.